'Just lie there and die': barriers to access and use of general practitioner out-of-hours services for older people in rural Ireland

Demographic changes and shifting populations mean growing numbers of older people are living alone in rural areas. General practitioner (GP) out-of-hours (GPOOH) services have an essential role in supporting older people to remain living in their own homes and communities for as long as possible, but little is known about use of GPOOH services by this cohort. This research examines how rurality impacts accessibility and utilisation of GPOOH services by people aged 65 years or more in rural Ireland. Conducted in the mainly rural counties of Cavan and Monaghan in the north-east of Ireland, this research used a mixed methods approach. Questionnaires and focus groups were conducted with 48 older people in six locations across both counties. A thematic analysis was conducted on the data using NVivo software. The challenge for older rural populations includes difficulties accessing transport and the limited availability of support networks during times of a health crisis, especially at night. The present findings show such challenges are further compounded by a lack of information about available services. Rurality complicates each of these challenges, because it adds to the vulnerability of older adults. This is most acutely felt by those who live alone and those living the furthest from GPOOH treatment centres. The most important concern for older people, when unwell outside doctor surgery hours, is the need for access to medical care as quickly as possible. Inability to use GPOOH services leads many older people to seek help from accident and emergency departments, where faster access to clinical care is sometimes assumed. For rural-dwelling older people, becoming ill outside GP surgery hours is complex and the barriers faced are often insurmountable at times of greatest need. Worries about accessibility and lack of information give rise to a hesitancy to use GPOOH services in a population that is already known to be reluctant to ask for help, even when such help is justified. In turn, the lack of familiarity with what is a fundamental community health service further impacts the willingness of older adults to call on GPOOH services for help when needed. Addressing the impact of rurality on access and use of out-of-hours medical services is essential to enable more older adults to live longer in their rural homes and communities, supported by services that are responsive to their needs regardless of where they live. Given GPOOH is the only current alternative